Division of Sports Medicine, Departments of Orthopedics and Pediatrics, Warren Alpert Medical School, Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, Rhode Island, USA.
Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA.
Am J Sports Med. 2022 Sep;50(11):3073-3082. doi: 10.1177/03635465221113859. Epub 2022 Aug 17.
Ulnar collateral ligament reconstruction (UCLR) surgeries have increased significantly in amateur and professional baseball pitchers. Although showcase participation has been considered an injury risk factor, limited data are available to corroborate this association.
Elite pitchers achieving fastball velocities ≥90, ≥92, and ≥95 mph at younger ages would be more likely to undergo UCLR earlier in their careers compared with pitchers not achieving these velocity thresholds at younger ages. Elite pitchers participating in high showcase volumes would be more likely to undergo UCLR compared with elite pitchers participating in fewer showcases.
Cohort study; Level of evidence, 3.
Descriptive, showcase performance, and injury data from pitchers selected in the first 5 rounds of the Major League Baseball draft (2011-2020) were gathered from publicly available databases. Continuous and categorical variables for pitchers undergoing UCLR and those not undergoing UCLR were compared, and multivariable analysis was performed using logistic regression. We used standard deviations (SDs) of ±1 SD of mean age at first UCLR to define early-career versus late-career UCLR subgroups after normal distribution was confirmed (Shapiro-Wilk test; = .183). The "early" UCLR group was defined as ≤-1 SD (19.09 years), whereas the "late" UCLR group was defined as ≥+1 SD (24.79 years). Trends in time were evaluated using linear regression.
Of the 845 pitchers selected, 659 pitchers (78.0%) had retrievable showcase performance data. Of the 845 pitchers, 229 (27.1%) underwent UCLR. Peak fastball velocity recorded at showcases was the strongest predictor of UCLR (adjusted odds ratio, 1.19; 95% CI, 1.02 to 1.39; = .03). Peak fastball velocity in high school (HS) was significantly higher among pitchers who underwent UCLR compared with pitchers in the no-UCLR group (91.57 vs 90.71 mph, respectively; 95% CI, -1.43 to -0.29; < .01). Age at which pitchers participated in their first HS showcase was significantly younger for the early versus the late UCLR group (15.53 vs 16.51 years, respectively; 95% CI, -1.53 to -0.41; < .01). Elite pitchers with early UCLR participated in nearly twice as many showcases compared with the late UCLR group (5.38 vs 2.89, respectively; 95% CI, 0.43 to 4.54; = .02). The mean number of HS showcases that elite pitchers attended more than doubled during the 2011-2020 study period (from 2.88 to 6.00 total showcases; < .001). Mean age at which pitchers attended their first HS showcase steadily declined as well over the 10-year period (from 16.52 to 15.63 years; < .001).
Peak fastball velocity was the strongest predictor of UCLR in elite pitchers before initiating professional careers. Elite amateur pitchers attended more showcases at younger ages in a decade-long trend. Overall, the variables included in this multivariable analysis were weak predictors, explaining only 3.8% of the variance in UCLR rates.
在业余和职业棒球投手中，尺侧副韧带重建（UCLR）手术的数量显著增加。虽然展示会的参与被认为是受伤的风险因素，但目前还没有足够的数据来证实这种关联。
在年轻时达到 90 英里/小时、92 英里/小时和 95 英里/小时以上的快速球速度的精英投手，与年轻时没有达到这些速度阈值的投手相比，他们在职业生涯早期更有可能接受 UCLR。与参加较少展示会的精英投手相比，参加更多展示会的精英投手更有可能接受 UCLR。
队列研究；证据水平，3 级。
从 2011 年至 2020 年参加美国职棒大联盟选秀首轮（第 1 至 5 轮）的投手中收集公开数据库中的描述性、展示会表现和受伤数据。对接受 UCLR 和未接受 UCLR 的投手的连续和分类变量进行比较，并使用逻辑回归进行多变量分析。我们使用标准偏差（SD）±1 个均数标准差来定义 UCLR 的早期和晚期亚组，以确认正态分布（Shapiro-Wilk 检验； =.183）。“早期”UCLR 组定义为≤-1 SD（19.09 岁），而“晚期”UCLR 组定义为≥+1 SD（24.79 岁）。使用线性回归评估时间趋势。
在 845 名被选中的投手中，有 659 名（78.0%）有可检索的展示会表现数据。在 845 名投手中，有 229 名（27.1%）接受了 UCLR。在展示会上记录的峰值快速球速度是 UCLR 的最强预测因素（调整后的优势比，1.19；95%置信区间，1.02 至 1.39； =.03）。与未接受 UCLR 的投手相比，接受 UCLR 的投手在高中（HS）的峰值快速球速度明显更高（分别为 91.57 英里/小时和 90.71 英里/小时；95%置信区间，-1.43 至-0.29； <.01）。接受 UCLR 的投手首次参加 HS 展示会的年龄比晚期 UCLR 组的年龄小（分别为 15.53 岁和 16.51 岁；95%置信区间，-1.53 至-0.41； <.01）。接受 UCLR 的精英投手参加的展示会数量几乎是晚期 UCLR 组的两倍（分别为 5.38 次和 2.89 次；95%置信区间，0.43 至 4.54； =.02）。在 2011 年至 2020 年的研究期间，精英投手参加的 HS 展示会数量平均增加了一倍以上（从 2.88 次增加到 6.00 次； <.001）。在 10 年期间，投手首次参加 HS 展示会的平均年龄也稳步下降（从 16.52 岁降至 15.63 岁； <.001）。
在开始职业生涯之前，峰值快速球速度是精英投手中 UCLR 的最强预测因素。在十年的时间里，业余精英投手在更年轻的时候参加了更多的展示会。总体而言，多变量分析中包含的变量是 UCLR 率的微弱预测因素，仅解释了 3.8%的方差。
